What's in store for WHO in 2025?

The World Health Organization had its hands full in 2024, dealing with several outbreaks while trying to raise more predictable funding for its work. The agency capped the year off with the opening of the WHO Academy in Lyon, and Director-General Tedros Adhanom Ghebreyesus spending Christmas week in Yemen to negotiate the release of detained U.N. staff members — while narrowly escaping death from an Israeli attack on the Yemeni airport in Sanaa. But 2025 promises to be equally busy if not more so for the United Nations health agency as it implements an ambitious new program of work while rallying member states to get the pandemic agreement to the finish line by May. WHO is also working on some initiatives, such as accelerating universal health coverage together with the World Bank and Japan, according to Catharina Boehme, assistant director-general for external relations and governance at WHO. She expects there will be a “huge initiative” on that to launch in the first half of 2025. Like many global development organizations, however, budget uncertainties plague the agency. Experts said the biggest challenge confronting WHO — yet again this year — will be resources. The agency launched an investment round last year to secure more predictable and flexible funding for its work from 2025 to 2028. However, the round has raised only $1.7 billion to date. When combined with other funding sources, WHO has $3.8 billion, leaving a funding gap of roughly $3.3 billion. On top of that, a potential U.S. withdrawal under incoming President Donald Trump, which experts say will have a significant impact on its funding and expertise, looms over the agency. While WHO has taken steps to diversify its donor base over the past year, the U.S. remains its biggest contributor, accounting for nearly 15% of its budget. The agency also has to contend with the political and fiscal realities of other donor countries, such as Germany, which is among its top 10 contributors but has been facing threats of recession in the past year. When Trump initiated WHO’s withdrawal in 2020, countries including Germany stepped up their support for the agency. However, Lawrence Gostin, distinguished university professor and founding O'Neill chair in global health law at Georgetown University, said political crises in Europe mean the region, “is unlikely to come to WHO's rescue, either economically or politically.” Other major donors such as the United Kingdom have already pledged £310 million ($392 million) as part of WHO’s investment round. “The UK has already done a big pledge, so it's probably not going to do more. So they're [WHO] looking at quite a tough period for their own financing,” Pete Baker, deputy director of the global health policy program at the Center for Global Development, told Devex. Meanwhile, major middle-income countries such as China, India, Brazil, and South Africa don’t have much of a track record of investment in multilateral agencies such as WHO, although engaging more with these countries will be important, Gostin said. An ambitious work program A key focus of the agency in 2025 is the implementation of its 14th program of work, GPW14, which experts said is more ambitious than ever. The agency is expanding its work on health systems and global health security to tackle modern challenges — that require working across different sectors — such as climate change, mental health, and addressing the social determinants of health. WHO is also revising its targets under this new program of work, from its triple billion targets to 5 billion people benefitting from universal health care without financial hardship, 7 billion people better protected from health emergencies and 6 billion people with better health and well-being. The targets are a shared responsibility with its member states and other health organizations, and WHO is stepping up partnerships, including with civil society and the private sector, to achieve them, according to Boehme. Implementation will however take place against a backdrop of challenges — multiple conflicts driving migration and displacement, an ever-increasing number of outbreaks, zoonotic spillovers and extreme weather events, changing geopolitics, dwindling trust in science, and the spread of misinformation, which the WHO has fallen victim to. Many of its donors are also struggling economically, or have shifting priorities. “They're putting their focus on sort of more national priorities, or they have to focus on regional conflicts and put more money in defense. So there's a lot of challenges out there that make us still feel that the implementation of GPW 14 is at risk, and with it the very concrete deliverables,” Boehme said. “For my fundraising team, it's absolutely not an easy time,” she said. Amid funding uncertainties, some WHO departments are worried about delivering some of their core functions, for example, in producing national health accounts, which track country health spending, according to Baker. “The officials that I speak to are planning for a very difficult financial period, and that is in part informed by the risk of a U.S. funding change, but it's in part just because of a poor investment round,” he added. WHO’s mandate also keeps expanding while much of its funding remains precarious. “Wherever I look, we are thinly spread. That cannot be debated. Our scope of work increases and increases and increases. For example, we already know that for the next World Health Assembly, 25 member states are working on 24 new resolutions, many of which would further broaden our mandate and are covering health areas that today we do not have teams working on,” Boehme said. “It's really sort of an added workload, for the most part, creating future pockets of poverty, let's say, and unfunded mandates,” she added. Every year, WHO member states pass a series of new resolutions — but some of them never receive funding. For example, a resolution in 2023 asking for WHO to develop a global action plan for the well-being of Indigenous people that WHO called historic has “not received a single dollar,” Boehme said. Funding challenges have an impact on WHO’s workforce. A new report by WHO’s ombudsman said it’s creating stress for those on temporary contracts who are unsure if they will be able to continue working for the organization. Gostin said many WHO staffers are paid for by the U.S.. “The executive board will go into a retreat, and one of the topics in that retreat in early February will be prioritization, and how can member states amongst each other also drive a stronger prioritization that would allow us as WHO Secretariat to focus in on the key priorities,” Boehme said. Continued fundraising Fundraising, including efforts focused on philanthropy, will remain a key priority for WHO throughout the year. For the investment round, which ends in May, Davos and an Asian philanthropy summit in Singapore will be key milestones ahead, Boehme said. WHO’s work program for the year is 90% funded, Boehme said, but some areas are better funded than others. Well-funded programs include their work on infectious diseases, as well as climate and health. Funding for noncommunicable diseases, which have historically received little funding, has also gone up. However, their work on neglected tropical diseases, and health emergency preparedness and response faces significant funding gaps. “Preparedness has always been a pocket of poverty,” she said. “It's never been, I would say, sexy to donors to invest in being prepared for the next outbreak, for the next pandemic. And unfortunately, that has not really changed with COVID.” Their emergency appeals are also disproportionately funded, with Sudan getting “almost no donor attention,” Boehme said. WHO is launching its 2025 health emergency appeal this week. It’s currently responding to 42 health emergencies, including 17 considered “severe.” The 90% funding for 2025 includes the assumption that U.S. funding will come through, which accounts for 20% of the total, Boehme said. She also stated that the U.S. provides about 20% of WHO’s assessed contributions at $130 million annually, as well as millions in voluntary contributions that go to specific health programs, including health preparedness and response, HIV and tuberculosis, and childhood vaccinations. Experts said that the funding impact of a potential U.S. withdrawal shouldn’t be immediate. Since the process takes 12 months from the moment the government initiates a withdrawal, the U.S. is still supposed to pay its dues to the organization within this period. But the president has a lot of leeway on what he wants to do with WHO funding. The last time Trump was in office, he froze funding to WHO. “There will certainly be some funding directly allocated by Congress and Trump can't overturn that. But he does have a lot of discretion on WHO funding,” Gostin told Devex. The potential of a withdrawal is a huge concern within the agency. But WHO has refrained from discussing it publicly, not wanting to respond to speculation. The aid agency has mainly said it hopes to continue working with the U.S. government. “We do not know what the new year will bring,” but “we will look to work constructively with any administration,” Boehme said. The push for a pandemic agreement At last year’s World Health Assembly, WHO member states agreed to continue negotiations on the pandemic agreement until May 2025 during the 78th WHA. While progress has been made on the text, member states have yet to agree on long-standing issues such as One Health and the pathogen access and benefit sharing system, or PABS. PABS is supposed to facilitate access to information on pathogens that could cause a pandemic and establish obligations for users to share benefits, such as vaccines, with countries through WHO. At this stage, Gostin said the “most likely scenario is a bare-bones treaty, with the key details to be negotiated in future years, through Annexes or Protocols” — which he said is better than negotiations collapsing completely. But he said there’s a high likelihood of the U.S. withdrawing from the negotiations, and the U.S. might even try to “persuade populist allies of President Trump to nix the treaty,” which “could prove disastrous for negotiations.” “There is another view, however, that with the US on the outside looking in, that diplomats might come together and forge a consensus. I would rather have the US at the table, but if Trump proves to be an obstacle, as is likely, then it is best to go ahead without the US,” he said. There are significant global implications to not having the U.S. part of a future pandemic agreement, for instance in access and sharing of medical products produced there. But the U.S. could also lose out when it comes to developing these products. “The US government and our pharmaceutical industry relies on scientific exchange to develop lifesaving vaccines and treatments. Without access to pathogen samples, genomic sequencing data and surveillance, the US will be flying blind in technology innovation,” Gostin said. Negotiations on the agreement have been going on for more than three years. If countries still fail to reach an agreement in May at the World Health Assembly, “the process will become politically moribund,” said Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. While key issues remain, she thinks a deal “is within reach if enough countries want one.” “It would be a colossal shame if it took another pandemic before we could agree on stronger international rules to govern them,” she added.